Testicular Tumor

Question 1

What markers are elevated in Seminoma Tumors?

Answer 1

LDH (40-60%) HCG (15-20%) AFP NEVER IN PURE Seminoma

Question 2

What markers are elevated in Choriocarcinoma? What other symptoms could this result in? Prognosis?

Answer 2

HGC: hyperthyroidism and gynecomastia (HCG has some cross-reactivity to TSH, LH, and FSH receptors Worse compared to other Testicular tumors

Question 3

What other places are Choriocarcinomas found?

Answer 3

placenta

ovary

mediastinum

abdomen

Question 4

Choriocarcinomas: Describe findings

Gross:

Micro:

Answer 4

Gross: small, may be replaced by fibrous scar with hemosiderin because it outgrows blood supply

Micro: hemorrhage and necrosis common; cytotrophoblasts (polygonal/round cells with distinct cell borders, clear cytoplasm and single bland nucleus) and syncytiotrophoblasts (large multinuclear cell with eosinophilic and vacuolated cytoplasm that produce HCG) are intermingled

Question 5

Polygonal/round cells with distinct cell borders, clear cytoplasm and single bland nucleus

Answer 5

cytotrophoblasts

Question 6

Large multinuclear cell with eosinophilic and vacuolated cytoplasm that produce HCG

Answer 6

syncytiotrophoblasts

Question 7

Most common testicular tumor for children under age 4.

What marker is elevated?

How does it differ in children vs adults?

Answer 7

Yolk Sac tumor

AFP Pure in children

Mixed in adults

Question 8

Yolk sac tumor

Gross

Micro:

Answer 8

Gross: nonencapsulated, homogenous, yellow-white, mucinous, soft, multicystic

Micro: lace like, papillary or cord-like pattern of cuboidal/elongated cells; cells have bland nuclei; 50% of tumors have Schiller-Duval bodies (also called endodermal sinuses, with central capillary and visceral and parietal layer of cells resembling primitive glomeruli)

Question 9

Schiller-Duval bodies are found in what tumor?

Answer 9

Yolk sac tumor

endodermal sinuses, with central capillary and visceral and parietal layer of cells resembling primitive glomeruli

Question 10

tumor is soft and much more variegated than the seminoma, with red to tan to brown areas, including prominent hemorrhage and necrosis

Answer 10

Embryonal Carcinoma

Question 11

Embryonal Carcinoma

Gross : What structure is being invaded?

Vs. Micro

Answer 11

Gross: variegated or pale-gray, poorly demarcated with hemorrhage and necrosis, usually invades tunica albuginea

Micro: primitive epithelial type cells with minimal features of differentiation; high grade features of large, epithelioid, anaplastic cells with prominent nucleoli, indistinct cell borders with nuclear overlapping, pleomorphism, frequent mitoses

Question 12

Tumur with Varying portions of ectodermal, endodermal, and mesodermal tissue. Is this Malignant?

Answer 12

Teratoma In males it is commonly malignant

Question 13

Initial treatment for testicular cancers?

After this initial treatments what are the options for localized vs Mets?

Answer 13

Radical inguinal orchiectomy Local=radiation after consulting with patient about benefits and risks–> can’t radiate METS

METS: Chemo: Bleomycin Etoposide Cisplatan

Question 14

Are most germ cell tumors are mixed or pure?

Answer 14

Mixed

Question 15

Seminomas route of metastasis?

Answer 15

Metastasize locally first to inguinal/para-aortic lymph nodes, then later, distantly

Question 16

What is RPLND?

Answer 16

retroperitoneal lymph node dissection used for nonseminomatous germ cell tumor

Question 17

Answer 17

Choriocarcinoma

Question 18

Answer 18

Yolk Sac Tumur

Schiller Duval Bodies

Question 19

Embryonal Carcinoma

Question 20

Answer 20

Teratoma